HEAD

JOSE ARNEL G. MANALILI, MD, FPSA, FPCGM, FICS

Associate Professor in Anatomy
Department of Anatomy
Fatima College of Medicine
 SKULL

CRANIAL - 8
FACIAL - 14
 JOINTS / ARTICULAR SYSTEM
ACCORDING TO MOBILITY
SYNARTHROSIS
AMPHIARTHROSIS
DIARTHROSIS
ACCORDING TO INTERVENING STRUCTURE
FIBROUS - suture, gomphosis, schindylesis, syndesmosis
CARTILAGINOUS – symphysis, synchondrosis
SYNOVIAL
WORMIAN SUTURAL BONE / INCA BONE
CALVARIUM
Frontal
Parietal
Temporal
Sphenoid
Occipital

PTERION*
- H-shaped union of:
1. Frontal
2. Parietal
3. Sphenoid
4. Temporal

*related to the MIDDLE

MENINGEAL ARTERY
 CRANIAL FOSSA
PART OF
FOSSA BONES BRAIN
LODGED
Ethmoid Frontal lobe of
Frontal Cerebrum
ANTERIOR Sphenoid (LW)

Sphenoid (GW and Body) Temporal lobe of

Temporal (Squamous and Cerebrum
MIDDLE Petrous)
Parietal
Temporal (Petrous and Brainstem
Mastoid) Cerebellum
POSTERIOR Sphenoid
Occipital
 ANTERIOR CRANIAL FOSSA

FORAMINA STRUCTURE/S AT
THE FORAMINA
Foramen Cecum Nasal emissary vein

Cribriform Plate of Ethmoid CN I

Anterior Ethmoidal Foramen Anterior ethmoidal n. and v.

Posterior Ethmoidal Foramen Posterior ethmoidal n. and v.

 MIDDLE CRANIAL FOSSA
FORAMINA STRUCTURE/S AT
THE FORAMINA
Optic canal CN II
Ophthalmic artery

Superior orbital fissure CN III, CN IV, CN V1,CN VI

Superior ophthalmic vein

Foramen rotundum CN V2

Foramen ovale CN V3
 FORAMINA STRUCTURE/S AT
THE FORAMINA
Foramen spinosum Middle meningeal artery

Foramen lacerum Internal carotid artery

 POSTERIOR CRANIAL FOSSA
FORAMINA STRUCTURE/S AT
THE FORAMINA
Internal auditory meatus CN VII, CN VIII
Labyrynthine artery

Jugular foramen CN IX, CN X, CN XI

Sigmoid sinus
Inferior petrosal sinus
Foramen magnum Spinal part of CN XI
Vertebral arteries
Anterior and posterior spinal arts.
Medulla oblongata, Meninges

Hypoglossal canal CN XII

LAYERS OF THE SCALP
Caput succedaneum vs.
Cephalhematoma
 NEUROVASCULAR
STRUCTURES OF THE SCALP
FRONTALIS m.
GALEA APONEUROTICA

NERVES/ARTERIES:
Supraorbital n/a
Supratrochlear n/a
Auriculotemporal n.
Superficial temporal a.
FRONTALIS m.
OCCIPITALIS m.
GALEA APONEUROTICA

NERVES/ARTERIES:
Supraorbital n/a
Supratrochlear n/a
Auriculotemporal n.
Superficial temporal a.
OCCIPITALIS m.
GALEA APONEUROTICA

NERVES/ARTERIES:
Auriculotemporal n.
Superficial temporal a.
Greater Occipital n.
Occipital a.
Lesser Occipital n.
Greater Auricular n.
Post. Auricular a.
 MENINGES

DURA MATER
- Pachymeninx
- toughest mater
- 2 layers: endosteal layer
meningeal layer
- with dural folds:
a. falx cerebri
b. falx cerebelli
c. tentorium cerebeli
d. diaphragma sella
- with dural venous sinuses

ARACHNOID MATER LEPTOMENINGES

PIA MATER
 INTRACRANIAL BLEEDING
EPIDURAL VESSEL: MIDDLE MENINGEAL ARTERY

OFTEN DUE TO FRACTURE OF

TEMPORAL BONE
LUCID INTERVAL
RAPID EXPANSION
TRANSTENTORIAL HERNIATION
CN III PALSY

BICONVEX (LENTIFORM) HYPERDENSE

BLD COLLECTION
NOT CROSSING SUTURE LINES,
CAN CROSS FALX CEREBRI

SUBDURAL VESSEL: CEREBRAL Vs.

SLOW VENOUS BLEEDING

ELDERLY, ALCOHOLICS, TRAUMA,
SHAKEN BABY SYNDROME

CRESCENT-SHAPED HGE.
CROSSES SUTURE LINES
CANNOT CROSS FALX CEREBRI
 INTRACRANIAL BLEEDING
SUBARACHNOID VESSEL: CEREBRAL ART.

RUPTURED ANEURYSM
(MARFAN,
EHLERS-DANLOS, AVM)
RAPID
“WHOML”
BLOODY OR XANTHOCHROMIC
SPINAL
TAP
BLOOD IN THE SULCI, WITHIN THE
VENTRICLES

INTRAPAREN- VESSEL: LATERAL LENTICULO-

STRIATE ARTERY
CHYMAL
(HYPERTENSIVE) MOSTLY DUE TO SYSTEMIC
HYPERTENSION
TYPICALLY INVOLVES BASAL
GANGLIA AND INT. CAPSULE

HEMORRHAGE IN THE BASAL GANGLIA

DURAL FOLDS and DURAL VENOUS
SINUSES
 DURAL VENOUS SINUSES

SUPERIOR SAGITTAL SINUS

INFERIOR SAGITTAL SINUS
OCCIPITAL SINUS
TRANSVERSE SINUS
STRAIGHT SINUS (sinus rectus)*

*formed by the union of the inferior sagittal sinus and the

great vein of Galen

** TORCULUS HEROPHILUS
 DURAL VENOUS SINUSES

CAVERNOUS SINUS

ANTERIOR AND POSTERIOR INTERCAVERNOUS SINUSES

SIGMOID SINUS
- exits through the jugular foramen to become the
internal jugular vein

SUPERIOR PETROSAL SINUS – connects the cavernous sinus

to the transverse sinus

INFERIOR PETROSAL SINUS – connects the cavernous sinus

to the internal jugular vein
DURAL FOLDS
DURAL FOLDS
DURAL FOLDS and DURAL VENOUS
SINUSES
DURAL FOLDS and DURAL VENOUS SINUSES
 CAVERNOUS SINUS
STRUCTURES:
A. at the lumen
1. internal carotid artery
2. sympathetic plexus
3. CN VI

B. at the lateral wall

1. CN III
2. CN IV
3. CN V1
4. CN V2
-Connected to the danger area of the face via an emissary vein,
the superior ophthalmic vein
- CAVERNOUS SINUS THROMBOSIS
CSF and VENTRICLES OF THE BRAIN
 CSF
VOLUME – 130 ML
COLOR – clear, colorless
PRESSURE - Supine: 60-150 mm H2O
Sitting: 150-300 mm H2O
CELL – LYMPHOCYTE (0-3 /cu. Mm.)
PROTEIN – less than 50 gm %
GLUCOSE – more than 50 gm%
HYDROCEPHALUS
1. OBSTRUCTIVE
2. NON-OBSTRUCTIVE
3. NORMAL PRESSURE
a. urinary incontinence
b. ataxia
c. dementia
 LATERAL VENTRICLE

FORAMEN OF MONRO

THIRD VENTRICLE ITER / AQUEDUCT OF

SYLVIUS

FOURTH VENTRICLE
 SUBARACHNOID CISTERNS

CISTERNA PONTIS CISTERNA CHIASMATIS

CISTERNA INTERPEDUNCULARIS CISTERNA SUPERIOR
CISTERNA MAGNA (CEREBELLO-
MEDULLARIS)
ARACHNOID GRANULATIONS
(PACCHIONIAN BODIES)
 QUECKENSTEDT
QUECKENSTEDT TEST
- upon compression of the internal jugular vein:
a. with change in CSF pressure : (-) Q.T.
~ NON-OBSTRUCTIVE HYDROCEPHALUS

b. no change in CSF pressure: (+) Q.T.

~ OBSTRUCTIVE HYDROCEPHALUS

QUECKENSTEDT SIGN
- observe change or no change in CSF pressure with
changes in PR and RR
( - ) Q.S. if with change in pressure
(+) Q.S. if with no change in pressure
BLOOD SUPPLY OF THE BRAIN

ANTERIOR CIRCULATION (INTERNAL CAROTID

ARTERY SYSTEM)
- provided by the internal carotid artery
- supplies 80% of the blood reaching the brain
- enters the cranial cavity via the carotid canal, foramen
lacerum
- in the cranial fossa, it enters the cavernous sinus
- with 5 major branches:
1. ophthalmic artery
2. anterior cerebral artery
3. choroidal artery
4. posterior communicating
5. middle cerebral artery
BLOOD SUPPLY OF THE BRAIN

POSTERIOR CIRCULATION (VERTEBRO-BASILAR

ARTERIAL SYSTEM)
- provided by the vertebral arteries from the 1st part of
subclavian artery
- enters the cranial cavity via the foramen magnum
- the 2 vertebral arteries unite at the ponto-medullary
junction to form the basilar artery
- Branches of vertebral artery:
1. anterior spinal artery
2. posterior spinal artery
3. medullary artery
4. meningeal artery
5. posterior inferior cerebellar artery
Branches of Basilar Artery:
1. pontine arteries
2. labyrinthine arteries
3. anterior inferior cerebellar arteries
4. superior cerebellar arteries
5. posterior cerebral arteries
 THE CIRCLE OF WILLIS
FORMED BY THE FOLLOWING
ARTERIES:
1. POSTERIOR CEREBRAL
2. BASILAR
3. POST. COMMUNICATING
4. INTERNAL CAROTID
5. ANTERIOR CEREBRAL
6. ANTERIOR COMMUNICATING
THE MOTOR AND SENSORY
HOMONCULUS
 CEREBRAL ARTERIES
ANTERIOR CEREBRAL ARTERY
- passes medially to the longitudinal fissure
- supplies the medial fronto-parietal areas and the
leg area of the ipsilateral cerebral hemisphere

MIDDLE CEREBRAL ARTERY

- the continuation of the internal carotid artery
- enters the ipsilateral Sylvian fissure and re-surface
to supply the lateral fronto-parietal areas and
upper lateral temporal area of the cerebrum
- gives rise to the lateral lenticulo-striate artery supplying
the basal ganglia and the posterior limb of the
internal capsule

POSTERIOR CEREBRAL ARTERY

- supplies the occipital lobe and the inferolateral temporal
areas of cerebrum
 CVA

ANTERIOR CIRCULATION STROKE

- involves the carotid system
- manifests as cortical lesions
1. Anterior cerebral artery
- deficit on contralateral lower extremity
2. Middle cerebral artery
a. cortical branches – cortical signs (alexia,aphasia,
deficit on contralateral upper extremity)
b. lateral lenticulostriate artery
- contralateral hemiplegia 2° to injury to
internal capsule
c. branch to optic radiation – contralateral homonymous
hemianopsia
 CVA
POSTERIOR CIRCULATION STROKE
- involves the vertebrobasilar system
- manifests chiefly as brainstem lesions
1. Posterior cerebral artery
a. calcarine artery –contralateral homonymous hemianopsia
b. branches to midbrain – Weber syndrome
2. Labyrinthine artery – tinnitus, hearing loss
3. Basilar artery – locked-in syndrome
4. Posterior inferior cerebellar artery – Wallenberg syndrome
5. Medullary artery – Medial Medullary syndrome
MUSCLES OF FACIAL EXPRESSION
MUSCLES OF FACIAL EXPRESSION
 MUSCLES OF FACIAL EXPRESSION

FRONTALIS
ORBICULARIS OCULI
ORBITAL PART
PALPEBRAL PART
CORRUGATOR SUPERCILI
FRONTALIS
ORBICULARIS OCULI
ORBITAL PART
PALPEBRAL PART
CORRUGATOR SUPERCILI

PROCERUS
NASALIS
DILATOR NARES
Orbicularis oris
Risorius
Zygomatic major
Zygomatic minor
Levator labi superioris
alaeque nasi
Levator labi superioris
Levator anguli oris
Depressor anguli oris
Depressor labi inferioris
Buccinator
Mentalis
FACIAL NERVE
 TRIGEMINAL NERVE
 GREAT AURICULAR NERVE
SENSORY INNERVATION OF THE FACE
 OPHTHALMIC NERVE

 LACRIMAL N.
 FRONTAL N.
 Supraorbital n.
 Suprathrochlear n.

 NASOCILIARY N.
 Posterior ethmoidal n.
 Ciliary ns.
 Anterior ethmoidal n.
 External nasal n.
 Infratrochlear n.
 MAXILLARY NERVE

 Posterior superior
alveolar ns.
 Zygomaticotemporal n.
 Zygomaticofacial n.
 Infraorbital n.
 MANDIBULAR NERVE
 N. to medial
pterygoid
 Meningeal branch
 Anterior division
 Deep temporal ns.
 N. to lateral pterygoid
 N. to masseter
 Buccal n.
 Posterior division
 Auriculotemporal n.
 Lingual n.
 Inferior alveolar n.
 N. to mylohyoid
 Mental n.
BLOOD SUPPLY OF THE FACE

FACIAL ART.
SUPERFICIAL TEMPORAL ART.
TRANSVERSE FACIAL ART.
VENOUS DRAINAGE OF THE FACE
 VEINS OF THE HEAD AND NECK
SUPERFICIAL TEMPORAL V. MAXILLARY V.

RETROMANDIBULAR V.

FACIAL V. ANT. POST. POST.

DIVISION DIVISION AURICULAR
V.

COMMON FACIAL V. EXTERNAL JUGULAR V.

INTERNAL JUGULAR V. SUBCLAVIAN V.

BRACHIOCEPHALIC VEIN
 PAROTID REGION
TEMPORAL FOSSA
INFRATEMPORAL FOSSA
TEMPOROMANDIBULAR JOINT
 SALIVARY GLANDS
SECRETION DUCT OPENING OF
DUCT/S
STENSEN’S ORAL
PAROTID GLAND SEROUS DUCT VESTIBULE

WHARTON’S SUBLINGUAL
SUBMANDIBULAR MIXED; more DUCT PAPILLA
GLAND of serous
SUBLINGUAL BARTHOLIN’S SUBLINGUAL
GLAND MIXED; more DUCT PAPILLA
of mucus DUCTS OF SUBLINGUAL
RIVINUS FOLD
BUCCAL FAT PAD
BUCCOPHARYNGEAL
FASCIA
BUCCINATOR
MUCOUS MEMBRANE
PARASYMPATHETIC CRANIAL NERVES
EFFECTOR
CN NUCLEUS GANGLION ORGAN
Ciliary muscle
EDINGER-
III CILIARY Sphincter
WESTPHAL pupillae
Lacrimal gland
SUPERIOR PTERYGOPALATINE Submandibular,
VII
SALIVATORY SUBMANDIBULAR sublingual
glands
INFERIOR
IX OTIC Parotid gland
SALIVATORY
Thoracic,
DORSAL
X plexuses abdominal
MOTOR viscera
 PARASYMPATHETIC CRANIAL
NERVES (Schema)
 1ST NEURON
INFERIOR NUCLEUS
- (NUCLEUS)
SALIVARY

Tympanic branch
Lesser superficial petrosal n.
 2NDOTIC
NEURON - (GANGLION)
GANGLION
Auriculotemporal n. SENSORY
PARASYMPATHETIC
SYMPATHETIC
 EFFECTOR
PAROTID ORGAN
GLAND
FREY SYNDROME
FREY SYNDROME

ERYTHEMA
FOCAL HYPERHIDROSIS
FACIAL NERVE
EXTERNAL CAROTID
art. and its terminal
branches
RETROMANDIBULAR VEIN
and its main tributaries
LYMPH NODES
TEMPORAL FOSSA
CONTENTS OF TEMPORAL
FOSSA
CONTENTS OF TEMPORAL FOSSA
CONTENTS OF TEMPORAL FOSSA
Infratemporal Fossa
Infratemporal Fossa
INFERIOR ORBITAL
FISSURE

PTERYGOMAXILLARY
FISSURE

PETROTYMPANIC
FISSURE
Muscles of Mastication

MASSETER
TEMPORALIS
LATERAL PTERYGOID
MEDIAL PTERYGOID
MANDIBULAR NERVE INJURY
Maxillary Artery
LANDMARK:
LATERAL PTERYGOID
 Maxillary Artery

 1st part (mandibular) - branches enter foramina/canals

e.g. EAM, petrotympanic fissure

 2nd part (pterygoid) -muscular branches

 3rd part (pterygopalatine) -pterygopalatine fossa

branches
 Maxillary Artery 1st part

 Deep auricular
 Anterior tympanic
 Middle meningeal
 Accessory meningeal
 Inferior alveolar
 Maxillary Artery 2nd part

 Masseteric
 Anterior deep temporal
 Posterior deep temporal
 Pterygoid
 Buccal
 Maxillary Artery 3rd part

 Posterior superior
alveolar
 Infraorbital
 Descending palatine
 Artery of pterygoid canal
 Pharyngeal
 Sphenopalatine
 Posterior superior
alveolar
 Infraorbital
 Descending palatine
 Artery of pterygoid canal
 Pharyngeal
 Sphenopalatine
PTERYGOID VENOUS PLEXUS
 MANDIBULAR NERVE
 N. to medial pterygoid
 Meningeal branch
 Anterior division
 Deep temporal ns.
 N. to lateral pterygoid
 N. to masseter
 Buccal n.
 Posterior division
 Auriculotemporal n.
 Lingual n.
 Inferior alveolar n.
 N. to mylohyoid
 Mental n.
MANDIBULAR NERVE
CHORDA TYMPANI and OTIC
GANGLION
CHORDA
TYMPANI

FACIAL
NERVE

LINGUAL
NERVE
TEMPOROMANDIBULAR JOINT
LIGAMENTS OF TMJ
TEMPOROMANDIBULAR JOINT
MOVEMENTS at TMJ

 SUPRAMENISCAL
COMPARTMENT:
protrusion /retraction

 INFRAMENISCAL
COMPARTMENT:
elevation/depression
MUSCLES ACTING at TMJ
EYELIDS, LACRIMAL
APPARATUS, ORBIT,
ORBITAL CONTENTS
 EYELIDS / PALPEBRAE

GLANDS OF Zeis, Moll, Meibomian

ECTROPION
ENTROPION
BLEPHARITIS
STYE / EXTERNAL HORDEOLUM
INTERNAL HORDEOLUM /CHALAZION/
MEIBOMIAN CYST
LACRIMAL APPARATUS

Lacrimal punctum

LACRIMAL FOLD OF HESNER

PARASYMPATHETIC CRANIAL NERVES
EFFECTOR
CN NUCLEUS GANGLION ORGAN
Ciliary muscle
EDINGER-
III CILIARY Sphincter
WESTPHAL pupillae
Lacrimal gland
SUPERIOR PTERYGOPALATINE Submandibular,
VII
SALIVATORY SUBMANDIBULAR sublingual
glands
INFERIOR
IX OTIC Parotid gland
SALIVATORY
Thoracic,
DORSAL
X plexuses abdominal
MOTOR viscera
CROCODILE TEAR / BOGORAD SYNDROME
DACRYOADENITIS
DACRYOCYSTITIS
EPIPHORA
Fig. 6.11
THE ORBIT
 THE ORBIT (CONTENTS)

Extraocular muscles
Lacrimal gland
Fascial sheath of the eyeball/Fascia
Bulbi/Tenon’s capsule
Nerves and blood vessels of the orbit
Eyeball
EXTRAOCULAR MUSCLES
FASCIA BULBI / TENON’S CAPSULE
 NERVES WITHIN THE ORBIT
 LACRIMAL N.
 FRONTAL N.
 Supraorbital n.
 Suprathrochlear n.
 NASOCILIARY N.
 Branch to ciliary ganglion
 Long Ciliary ns.
 Posterior ethmoidal n.
 Anterior ethmoidal n.
 External nasal n.
 Infratrochlear n.
 TROCHLEAR N.
 OCULOMOTOR N.
 OPTIC N.
CILIARY GANGLION
PARASYMPATHETIC CRANIAL NERVES
EFFECTOR
CN NUCLEUS GANGLION ORGAN
Ciliary muscle
EDINGER-
III CILIARY Sphincter
WESTPHAL pupillae
Lacrimal gland
SUPERIOR PTERYGOPALATINE Submandibular,
VII
SALIVATORY SUBMANDIBULAR sublingual
glands
INFERIOR
IX OTIC Parotid gland
SALIVATORY
Thoracic,
DORSAL
X plexuses abdominal
MOTOR viscera
 LAYERS OF EYEBALL
 FIBROUS COAT
CORNEA
SCLERA
 UVEA/ VASCULAR PIGMENTED COAT
CHOROID
IRIS
CILIARY BODY
RING
MUSCLE
PROCESS
NERVOUS COAT(RETINA)
LAMINA CRIBROSA
 (sphincter pupillae) (dilator pupillae)

miosis mydriasis
 ACCOMODATION REFLEX
 CILIARY MUSCLE CONTRACTS
 SUSPENSORY LIGAMENT OF LENS BECOMES LAXED
 LENS BECOMES MORE CONVEX
 IMAGE FOCUSED ON THE RETINA

PRESBYOPIA – farsightedness (in the elderly) due to

loss of elasticity of the lens
 RETINA

 PHOTORECEPTORS
 RODS
- nocturnal vision
 CONES
- day vision
- color vision
- visual acuity
fundoscopy
 CONTENTS OF EYEBALL
 AQUEOUS HUMOR
 VITREOUS BODY/HUMOR
 LENS
REFRACTION
 AQEOUS HUMOR

 Ciliary process
 Posterior chamber
 Pupil
 Anterior chamber
 SPACES of Fontana
 Schlemm’s canal

GLAUCOMA - with increased intraocular pressure

EAR
AURICLE
 HELIX
 CRUS OF THE HELIX
 ANTIHELIX
 CRURA OF THE ANTIHELIX
 FOSSA TRIANGULARIS
 SCAPHOID FOSSA
 CAVUM CONCHA
 TRAGUS
 ANTITRAGUS
 INTERTRAGIC NOTCH
 LOBULE
OTOSCOPY
 TYMPANIC MEMBRANE
UMBO
HANDLE OF
MALLEUS
CONE OF LIGHT
ANTERIOR AND
POSTERIOR
MALLEOLAR FOLDS
PARS FLACCIDA
(Shrapnell’s membrane)
PARS TENSA
OSSICLES
Walls of Tympanic Cavity
 MEMBRANOUS
BONY LABYRINTH
LABYRINTH

COCHLEAR DUCT
COCHLEA
(RECEPTOR: organ of Corti)

UTRICLE
VESTIBULE SACCULE
(RECEPTOR: macula)
SEMICIRCULAR DUCTS
SEMICIRCULAR CANALS
(RECEPTOR: cristae ampullaris
ORGAN OF CORTI MACULA

CRISTA
AMPULLARIS
ORGAN OF CORTI
 MACULA
- Hair cells
- otolithic membrane
- detects linear acceleration
position of the head
CRISTAE AMPULLARIS
- Hair cells
- Cupula
- detects angular acceleration
 DEAFNESS

 CONDUCTION
 SENSORINEURAL
 TESTS TO ASSESS DEAFNESS
 WEBER’S TEST
- loud in affected ear: conduction deafness
- loud in unaffected ear/decreased
in affected ear: sensorineural deafness
 RINNE’S TEST
- NORMAL FINDING:
AIR CONDUCTION > BONE
CONDUCTION
- if A≤ B: conduction deafness
WEBER TEST
RINNE TEST
NASAL CAVITY
ORAL CAVITY
PHARYNX
 EXTERNAL NOSE

 ROOT
 BRIDGE/DORSUM
 TIP

 ANTERIOR
NARES/NOSTRIL
 COLUMELLA
PIRIFORM APERTURE
NASAL SEPTUM

2 3
 NOSE BLEEDING
(EPISTAXIS)
 ANTERIOR
- KIESSELBACH’S
PLEXUS

 POSTERIOR
WOODRUFF’SPLEXUS
BLOOD VESSELS
1. Sphenopalatine
2. Anterior ethmoidal
3. Superior labial
NERVES
1. Long sphenopalatine
2. Short sphenopalatine
3. Medial septal branch of
anterior ethmoidal
MIDDLE MEATUS

BULLA ETHMOIDALIS

HIATUS SEMILUNARIS
 PARANASAL SINUSES

-Serves to lighten the skull and

resonates voice

_ open to the meatuses and

sphenoethmoidal recess

1. SPHENOIDAL sinus
2. FRONTAL sinus
3. ANTERIOR ETHMOIDAL sinus
4. MIDDLE ETHMOIDAL sinus
5. POSTERIOR ETHMOIDAL sinus
6. MAXILLARY sinus

* ANTRUM OF HIGHMORE – refers

to the maxillary sinus
 OPENINGS AT NASAL CAVITY
RECESS/ MEATUS

SPHENOIDAL SINUS SPHENOETHMOIDAL RECESS

POST. ETHMOIDAL SINUS SUP. MEATUS

MIDDLE ETHMOIDAL SINUS

ANTERIOR ETHMOIDAL SINUS MIDDLE MEATUS
MAXILLARY SINUS
FRONTAL SINUS

NASOLACRIMAL DUCT INFERIOR MEATUS

 OPENINGS OF THE
PARANASAL SINUSES
 SALIVARY GLANDS
SECRETION DUCT OPENING OF
DUCT/S
STENSEN’S ORAL
PAROTID GLAND SEROUS DUCT VESTIBULE

WHARTON’S SUBLINGUAL
SUBMANDIBULAR MIXED; more DUCT PAPILLA
GLAND of serous
SUBLINGUAL BARTHOLIN’S SUBLINGUAL
GLAND MIXED; more DUCT PAPILLA
of mucus DUCTS OF SUBLINGUAL
RIVINUS FOLD
KOPLIK’S SPOT =pathognomonic sign of
measles
 GENIOGLOSSUS
HYOGLOSSUS
STYLOGLOSSUS
PALATOGLOSSUS

NS: hypoglossal n.except

palatoglossal (vagus nerve via
pharyngeal plexus)
MUSCLES OF THE SOFT
PALATE
TENSOR VELI PALATINI
LEVATOR VELI PALATINI
PALATOGLOSSSUS
PALATOPHARYNGEUS
UVULAE

NS: VAGUS except tensor veli

palatini (supplied by CN V3 –
lingual nerve)
MUSCLES OF PHARYNX

1. SUPERIOR PHARYNGEAL
2. MIDDLE CONSTRICTOR
3. INFERIOR
4. PALATOPHARYNGEUS
5. SALPINGOPHARYNGEUS
6. STYLOPHARYNGEUS

NS: VAGUS n. except

stylopharyngeus (supplied
by CN IX)
PHARYNX
NASOPHARYNX
(EPIPHARYNX)
OROPHARYNX
(MESOPHARYNX)
 LARYNGOPHARYNX
(HYPOPHARYNX)

Boundaries:
anterior: epiglottis

posterior: arytenoid cartilages

interarytenoid notch
lateral: aryepiglottic fold
NECK
 LAYERS OF THE NECK
I. SKIN
II. SUPERFICIAL FASCIA
1. MUSCLE : Platysma
2. SUPERFICIAL VESSELS: External Jugular vein and
tributaries
a. External Jugular Vein
- Tributaries:
post. Division of retromandibular v.
post. Auricular v.
post. Ext. jugular v.
transverse cervical v.
suprascapular v.
ant. Jugular v.
CLEAVAGE/ TENSION LINES OF
LANGER
 LAYERS OF THE NECK
I. SKIN
II. SUPERFICIAL FASCIA
1. MUSCLE : Platysma
2. SUPERFICIAL VESSELS: External Jugular vein and
tributaries
a. External Jugular Vein
- Tributaries:
post. Division of retromandibular v.
post. Auricular v.
post. Ext. jugular v.
transverse cervical v.
suprascapular v.
ant. Jugular v.
 SUPERFICIAL FASCIA

CUTANEOUS NERVES: Branches of Cervical Plexus

1) lesser occipital nerve (ant. ramus of C2)

2) great auricular nerve (ant. rami of C2-C3)
3) transverse cervical / coli nerve (ant. rami of C2-
C3)
4) supraclavicular nerve (ant. rami of C3-C4)
LON
GAN C1

C2

TCN
C3

C4

SCN
 CN XII

C1

C2
DESCENDENS
HYPOGLOSSI

C3

C4 DESCENDENS
CERVICALIS

ANSA
CERVICALIS
 C1

C2

C3

C4

C5
PHRENIC N.
 DEEP FASCIA
1. INVESTING
2. PRETRACHEAL
3. PREVERTEBRAL

CAROTID SHEATH – condensation of the 3 fasciae

- Contents:
a. common carotid artery
b. internal carotid artery
c. internal jugular vein
d. vagus nerve
e. deep cervical nodes
 TRIANGLES OF THE NECK
I. ANTERIOR TRIANGLE
1. Submental
2. Digastric/Submandibular
3. Carotid
4. Muscular

II. POSTERIOR TRIANGLE

1. Occipital
2. Subclavian/Supraclavicular
INTERNAL LARYNGEAL N.
SUPERIOR LARYNGEAL A.

EXTERNAL LARYNGEAL N.
SUPERIOR THYROID A.

RECURRENT LARYNGEAL N.
INFERIOR THYROID A.
 VAGUS NERVE
 SUPERIOR (JUGULAR) GANGLION
MENINGEAL BRANCH
AURICULAR BRANCH

 INFERIOR (NODOSE) GANGLION

PHARYNGEAL BRANCH
SUPERIOR LARYNGEAL BRANCH

 RECURRENT LARYNGEAL NERVE

FIBROELASTIC MEMBRANE
INTRINSIC LARYNGEAL MUSCLES
 CRICOTHYROID (tensor)
 THYROARYTENOID (relaxor)
 POST. CRICOARYTENOID (abductor)
 TRANSVERSE ARYTENOID
 OBLIQUE ARYTENOID (adductors)
 LATERAL CRICOARYTENOID

 ARYEPIGLOTTIC (close the laryngeal inlet)

 OBLIQUE ARYTENOID
 VOCALIS (alter the pitch of voice)
TUBERCLE OF ZUCKERKANDL and
the
LIGAMENT OF BERRY
Thank you!